Water filling station swipe card application

Complete this application to receive access to our water filling stations.

Required fields are marked with an asterisk (*).

Customer type *

For billing purposes, please select one:

Residential customer

Business customer

Applicant details

Customer ID (if known)

Given name(s)

Surname

Phone

Email

Date of birth

Driver's licence number

State of issue

There is more than one applicant

Applicant two

Given name(s)

Surname

Phone

Email

Date of birth

Driver's licence number

State of issue

Business details

Customer ID (if known)

Business/company name

ABN/ARBN

Name of person responsible for this application

Phone

Email

Postal address

Street address *

Suburb *

State *

Postcode *

Collection

How would you like to collect your swipe cards? *

How many swipe cards do you require? *

Terms and conditions *

I/We agree that I/we will be billed monthly (end of each month).

I/We agree that I/we will be liable for consumption if misplaced card(s) is/are not immediately reported to Power and Water Corporation.

I/We understand that in accordance with the Privacy Act, details of uncollected debts more than 60 days overdue may be referred to a credit reporting agency and then become available to other credit providers.

I/We understand that once I/we no longer require the swipe card(s) I am to return card(s) to Power and Water Corporation. Card(s) can be returned at a Customer Service Centre or post it to GPO Box 3596, Darwin NT 0801.

I/We understand and accept that Power and Water Corporation may store personal information in paper and electronic formats. Power and Water Corporation takes steps to ensure the security of all information provided by maintaining in a secure environment accessed only by authorised personnel. However, any data sent over the internet or stored on internet servers cannot be guaranteed to be fully secure. These activities are taken at your risk.

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Power and Water Corporation is responsible for electricity transmission and distribution and it provides water and sewerage services across the Northern Territory, an area of more than 1.3 million square kilometres. Power and Water also supplies electricity generation and retail services to 72 remote communities through its not-for-profit subsidiary, Indigenous Essential Services Pty Ltd (IES).

Power and Water Corporation is responsible for electricity transmission and distribution and it provides water and sewerage services across the Northern Territory, an area of more than 1.3 million square kilometres. Power and Water also supplies electricity generation and retail services to 72 remote communities through its not-for-profit subsidiary, Indigenous Essential Services Pty Ltd (IES).